Provider Demographics
NPI:1962867721
Name:CLYDE, KRISTIN LEIGH (MPT)
Entity type:Individual
Prefix:MRS
First Name:KRISTIN
Middle Name:LEIGH
Last Name:CLYDE
Suffix:
Gender:F
Credentials:MPT
Other - Prefix:MISS
Other - First Name:KRISTIN
Other - Middle Name:LEIGH
Other - Last Name:FRESHCORN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MPT
Mailing Address - Street 1:273 ROUTE 288
Mailing Address - Street 2:
Mailing Address - City:ELLWOOD CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16117-3055
Mailing Address - Country:US
Mailing Address - Phone:724-758-7044
Mailing Address - Fax:724-752-6845
Practice Address - Street 1:273 ROUTE 288
Practice Address - Street 2:
Practice Address - City:ELLWOOD CITY
Practice Address - State:PA
Practice Address - Zip Code:16117-3055
Practice Address - Country:US
Practice Address - Phone:724-758-7044
Practice Address - Fax:724-752-6845
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPT015517225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist